Provider Demographics
NPI:1548386147
Name:NORTHWESTERN R-I SCHOOL
Entity Type:Organization
Organization Name:NORTHWESTERN R-I SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLADBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-272-3201
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:18475 HWY 11
Mailing Address - City:MENDON
Mailing Address - State:MO
Mailing Address - Zip Code:64660-0043
Mailing Address - Country:US
Mailing Address - Phone:660-272-3201
Mailing Address - Fax:660-272-3419
Practice Address - Street 1:18475 HWY 11
Practice Address - Street 2:NORTHWESTERN R-I SCHOOL
Practice Address - City:MENDON
Practice Address - State:MO
Practice Address - Zip Code:64660-0043
Practice Address - Country:US
Practice Address - Phone:660-272-3201
Practice Address - Fax:660-272-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506083005Medicaid